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* 1. During your most recent visit, did your healthcare provider listen carefully to you?

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* 2. Overall, how satisfied or dissatisfied were you with your last visit to our office?

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* 3. Overall, how would you rate the service you received from the staff at our office?

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* 4. Is there anything we could have done to improve your last visit?

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* 5. How likely is it that you would recommend Coupet Quality Clinic -
Direct Primary Care
to a friend or colleague?

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* 6. Have you been made aware of our DPC Referral Program ?

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* 7. What do you enjoy about Coupet Quality Clinic - Choose all that apply

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* 8. I am excited to take advantage of the following CQC services

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* 9. Do you completely understand the "Direct primary Care" program and all of the services that are offered to you through this program?

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* 10. Which CQC team members were exceptionally curtious or helpful to you durring your visit ? 

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